Deductible Amount

Deductible amount applied to patient responsibility. The payer processed the claim but payment is reduced by the patient's unmet annual deductible.

What This Means in Behavioral Health

BH residential claims often apply large deductible amounts to institutional per diem lines. Admissions teams need deductible status before financial conversations—PR-1 on remittance confirms patient owes until deductible is met.

Root Causes

• Patient deductible not yet satisfied for plan year
• Deductible applies to BH benefit separately from medical deductible on some plans
• Family vs individual deductible aggregation misunderstood at admission
• Incorrect deductible amount quoted during VOB

Prevention Tips

• Include deductible remaining in admission VOB summary
• Post PR-1 to patient ledger promptly with clear statements
• Re-run eligibility in January and on plan year resets
• Coordinate financial counseling for high-deductible plans before RTC admit